Provider Demographics
NPI:1336854900
Name:JEPSEN, ERICA (PA-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:JEPSEN
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2061 N SOUTHPORT AVE APT 328
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6938
Mailing Address - Country:US
Mailing Address - Phone:815-701-6844
Mailing Address - Fax:
Practice Address - Street 1:85 W ALGONQUIN RD STE 220
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4423
Practice Address - Country:US
Practice Address - Phone:847-381-8899
Practice Address - Fax:847-381-8999
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-02-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant